Montana State University

Health Benefits for Employees


Below are links to forms and websites to help you answer your benefits questions. For additional assistance please contact Human Resources at 994-3651.

CHOICES Forms

FY14 CHOICES (2013-2014)

Summary of Benefits and Coverage
CHOICES Blue Cross Managed Care
CHOICES Allegiance Managed Care
CHOICES Pacific Source Managed Care
CHOICES Traditional Coverage

CHOICES FY14 Workbook
CHOICES FY14 Enrollment Form
CHOICES Retiree Enrollment Form
CHOICES Retiree Workbook
CHOICES Active Employee Mid-Year Change
COBRA Enrollment Form
MAP Enrollment Form

FY15 CHOICES (2014-2015)

CHOICES FY15 Workbook
CHOICES Retiree FY15 Workbook
2014/2015 CHOICES Enrollment Form
Retiree Enrollment Form
2014/2015 CHOICES Mid-Year Change Form

General

Adult Dependent
Allegiance Authorization to Release Confidential Information
Allegiance Medical Claim Form
Allegiance Physician's Statement of Disability
Alternate ID Form
Benefit Providers Contact Information
Blue Cross Blue Shield International Claim Form
Change in Beneficiary
Prescription Reimbursement Form
EyeMed Out of Network Claim Form
Ridgeway Enrollment Form
Family Medical Leave Form
Family Medical Leave Fact Sheet
Montana Medical Care Savings Account

CHOICES Informational Links

Allegiance Card Instructions (How to Read)
Allegiance Website Guide for Employees
Healthy Montana Kids
Frontier MEDEX Travel Assist brochure/card
MSU Benefits Committee
Standard Additional Life Insurance Information
Standard Life & Disability Information
Standard Travel Benefit Brochure
Standard Travel Benefit Brochure (Ex pat-over 90 days)
Standard Travel Benefit Form (Ex pat-over 90 days)
Summary Plan Description
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